If you're a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:


Note: To download Adobe Acrobat Reader for free, click here.

1009 SW Main Blvd Suite 115B ∙ Lake City, FL 32025
email:
heartcentered@shaledamirralcsw.com

Sha'Leda Mirra, MS, MSW, LCSW, CAP

(352) 247-2383

Book Me for your next Mental Wellness Workshop!